Dermatoses of pregnancy
- Recognise and manage common or important skin conditions arising in pregnancy.
Pregnancy may result in an increase in prevalence or severity of some common skin problems. These include:
- Atopic dermatitis and psoriasis (may instead improve or remit)
- Acne (often improves in late pregnancy)
- Perioral dermatitis
- Telogen effluvium (postpartum shedding)
- Striae gravidarum
- Pyogenic granuloma
- Pigmentary disturbance (melasma).
Palmar erythema of pregnancy
Pyogenic granuloma in pregnancy
Pustular psoriasis in pregnancy (impetigo herpetiformis)
Pregnancy makes management more difficult as many medications should be avoided. Refer to standard texts if you are prescribing for a pregnant or lactating female.
Acne management in pregnancy can include the topical agents benzoyl peroxide and azelaic acid, and oral erythromycin for severe cases. Salicylic acid, topical and oral retinoids and tetracyclines should be avoided. Topical steroids and tar preparations are permitted for inflammatory skin diseases; in some cases oral steroids may be necessary.
Prurigo of pregnancy
Itching is relatively prevalent in pregnancy. Causes include scabies, atopic eczema, contact dermatitis etc. In some cases, the itch is sometimes related to cholestasis and in others the cause is unknown.
Prurigo of pregnancy presents as scattered itchy/scratched papules at any stage of pregnancy. Often no primary lesion can be found. It should be managed with emollients, and topical steroids may help individual papules.
Prurigo of pregnancy
PUPPP is an acronym for Pruritic Urticated Papules and Plaques of Pregnancy, and is also known as polymorphous eruption of pregnancy. Features include:
- Onset of PUPPP is in 3rd trimester and remission occurs within a few days of delivery
- It more frequently arises in primigravidae and multiple pregnancies
- Itchy erythematous papules and plaques first appear on abdominal striae and then spread to trunk and proximal limbs
- Direct immunofluorescence is negative (unlike pemphigoid gestationis)
- Emollients, medium potency topical steroids and sedative oral antihistamines provide relief of symptoms.
Pemphigoid gestationis is a rare blistering disease due to circulating autoantibodies similar to bullous pemphigoid. Features include:
- The onset of pemphigoid gestationis is most often in the 2nd trimester, but it may arise at any stage and may even be worse postpartum
- It can recur with menstruation, with oral contraceptives and in further pregnancies
- The pruritic papulovesicular eruption mainly affects the abdomen but may generalise, with grouped or annular erythematous papules, plaques and bullae
- Direct immunofluorescence shows deposition of C3 and or IgG or other antibodies
- Severe pemphigoid gestationis should be treated by oral corticosteroids.